Basic Information
| Provider Information | |||||||||
| NPI: | 1043707102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUONG | ||||||||
| FirstName: | KRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 N MOPAC EXPY | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787582401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014937 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 CEDAR BEND DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014026 | ||||||||
| FaxNumber: | 5129013940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2018 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | S9424 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.